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Rajasimman AS, Patil V, Gala KB, Shetty N, Kulkarni S, Ramadwar MS, Qureshi SS, Chinnaswamy G, Laskar S, Baheti AD. Accuracy of contrast-enhanced CT in liver neoplasms in children under 2 years age. Pediatr Radiol 2024:10.1007/s00247-024-05958-w. [PMID: 38831055 DOI: 10.1007/s00247-024-05958-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Multiple differentials exist for pediatric liver tumors under 2 years. Accurate imaging diagnosis may obviate the need for tissue sampling in most cases. OBJECTIVE To evaluate the imaging features and diagnostic accuracy of computed tomography (CT) in liver tumors in children under 2 years. METHODS Eighty-eight children under 2 years with treatment naive liver neoplasms and baseline contrast-enhanced CT were included in this institutional review board approved retrospective study. Two blinded onco-radiologists assessed these tumors in consensus. Findings assessed included enhancement pattern, lobulated appearance, cystic change, calcifications, central scar-like appearance, and metastases. The radiologists classified the lesion as hepatoblastoma, infantile hemangioma, mesenchymal hamartoma, rhabdoid tumor, or indeterminate, first based purely on imaging and then after alpha-fetoprotein (AFP) correlation. Multivariate analysis and methods of comparing means and frequencies were used for statistical analysis wherever applicable. Diagnostic accuracy, sensitivity, and positive predictive values were analyzed. RESULTS The mean age of the sample was 11.4 months (95% CI, 10.9-11.8) with 50/88 (57%) boys. The study included 72 hepatoblastomas, 6 hemangiomas, 4 mesenchymal hamartomas, and 6 rhabdoid tumors. Presence of calcifications, multilobular pattern of arterial enhancement, lobulated morphology, and central scar-like appearance was significantly associated with hepatoblastomas (P-value < 0.05). Fourteen out of eighty-eight lesions were called indeterminate based on imaging alone; six lesions remained indeterminate after AFP correlation. Pure radiology-based diagnostic accuracy was 81.8% (95% CI, 72.2-89.2%), which increased to 92.1% (95% CI, 84.3-96.7%) (P-value > 0.05) after AFP correlation, with one hepatoblastoma misdiagnosed as a rhabdoid tumor. If indeterminate lesions were excluded for biopsy, the accuracy would be 98.8% (95% CI, 93.4-99.9%). CONCLUSION CT had high accuracy for diagnosing liver neoplasms in the under 2-year age population after AFP correlation. Certain imaging features were significantly associated with the diagnosis of hepatoblastoma. A policy of biopsying only indeterminate lesions after CT and AFP correlation would avoid sampling in the majority of patients.
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Affiliation(s)
- Aishvarya Shri Rajasimman
- Department of Radiodiagnosis, Tata Memorial Centre & Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Vasundhara Patil
- Department of Radiodiagnosis, Tata Memorial Centre & Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Kunal Bharat Gala
- Department of Radiodiagnosis, Tata Memorial Centre & Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Nitin Shetty
- Department of Radiodiagnosis, Tata Memorial Centre & Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Suyash Kulkarni
- Department of Radiodiagnosis, Tata Memorial Centre & Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Mukta S Ramadwar
- Department of Pathology, Tata Memorial Centre & Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Sajid S Qureshi
- Department of Surgical Oncology, Tata Memorial Centre & Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Centre & Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Centre & Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Akshay D Baheti
- Department of Radiodiagnosis, Tata Memorial Centre & Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India.
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de Faria LL, Ponich Clementino C, Véras FASE, Khalil DDC, Otto DY, Oranges Filho M, Suzuki L, Bedoya MA. Staging and Restaging Pediatric Abdominal and Pelvic Tumors: A Practical Guide. Radiographics 2024; 44:e230175. [PMID: 38722785 DOI: 10.1148/rg.230175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
The most common abdominal malignancies diagnosed in the pediatric population include neuroblastoma, Wilms tumor, hepatoblastoma, lymphoma, germ cell tumor, and rhabdomyosarcoma. There are distinctive imaging findings and patterns of spread for each of these tumors that radiologists must know for diagnosis and staging and for monitoring the patient's response to treatment. The multidisciplinary treatment group that includes oncologists, surgeons, and radiation oncologists relies heavily on imaging evaluation to identify the best treatment course and prognostication of imaging findings, such as the image-defined risk factors for neuroblastomas, the PRETreatment EXtent of Disease staging system for hepatoblastoma, and the Ann Arbor staging system for lymphomas. It is imperative for radiologists to be able to correctly indicate the best imaging methods for diagnosis, staging, and restaging of each of these most prevalent tumors to avoid inconclusive or unnecessary examinations. The authors review in a practical manner the most updated key points in diagnosing and staging disease and assessing response to treatment of the most common pediatric abdominal tumors. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Luisa Leitão de Faria
- From the Radiology Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP 36070-460, Brazil (L.L.d.F., C.P.C., F.A.S.e.V., D.d.C.K., D.Y.O., M.O.F., L.S.); and Department of Radiology, Boston Childrens Hospital, Harvard Medical School, Boston, Mass (M.A.B.)
| | - Carolina Ponich Clementino
- From the Radiology Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP 36070-460, Brazil (L.L.d.F., C.P.C., F.A.S.e.V., D.d.C.K., D.Y.O., M.O.F., L.S.); and Department of Radiology, Boston Childrens Hospital, Harvard Medical School, Boston, Mass (M.A.B.)
| | - Felippe Augusto Silvestre E Véras
- From the Radiology Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP 36070-460, Brazil (L.L.d.F., C.P.C., F.A.S.e.V., D.d.C.K., D.Y.O., M.O.F., L.S.); and Department of Radiology, Boston Childrens Hospital, Harvard Medical School, Boston, Mass (M.A.B.)
| | - Douglas da Cunha Khalil
- From the Radiology Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP 36070-460, Brazil (L.L.d.F., C.P.C., F.A.S.e.V., D.d.C.K., D.Y.O., M.O.F., L.S.); and Department of Radiology, Boston Childrens Hospital, Harvard Medical School, Boston, Mass (M.A.B.)
| | - Deborah Yukiko Otto
- From the Radiology Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP 36070-460, Brazil (L.L.d.F., C.P.C., F.A.S.e.V., D.d.C.K., D.Y.O., M.O.F., L.S.); and Department of Radiology, Boston Childrens Hospital, Harvard Medical School, Boston, Mass (M.A.B.)
| | - Marcelo Oranges Filho
- From the Radiology Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP 36070-460, Brazil (L.L.d.F., C.P.C., F.A.S.e.V., D.d.C.K., D.Y.O., M.O.F., L.S.); and Department of Radiology, Boston Childrens Hospital, Harvard Medical School, Boston, Mass (M.A.B.)
| | - Lisa Suzuki
- From the Radiology Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP 36070-460, Brazil (L.L.d.F., C.P.C., F.A.S.e.V., D.d.C.K., D.Y.O., M.O.F., L.S.); and Department of Radiology, Boston Childrens Hospital, Harvard Medical School, Boston, Mass (M.A.B.)
| | - M Alejandra Bedoya
- From the Radiology Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos, 225 Cerqueira César, São Paulo, SP 36070-460, Brazil (L.L.d.F., C.P.C., F.A.S.e.V., D.d.C.K., D.Y.O., M.O.F., L.S.); and Department of Radiology, Boston Childrens Hospital, Harvard Medical School, Boston, Mass (M.A.B.)
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Gong XH, Feng MX, Zhuang ZG, Yan YQ, Wang L, Ren HN, Zhu Y, Song Y, Qian LJ, Xu JR, Zhou Y, Xia Q. Pediatric Hepatoblastoma After Neoadjuvant Chemotherapy: Diagnostic Performance of MR in Staging POSTTEXT and Vascular Involvement. J Magn Reson Imaging 2024; 59:1034-1042. [PMID: 37272790 DOI: 10.1002/jmri.28848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND The assessment of resectability after neoadjuvant chemotherapy of hepatoblastoma is dependent on Post-Treatment EXTENT of Disease (POSTTEXT) staging and its annotation factors P (portal venous involvement) and V (hepatic venous/inferior vena cava [IVC] involvement), but MR performance in assessing them remains unclear. PURPOSE To assess the diagnostic performance of contrast-enhanced MR imaging for preoperative POSTTEXT staging and diagnosing vascular involvement in terms of annotation factors P and V in pediatric hepatoblastoma following neoadjuvant chemotherapy. STUDY TYPE Retrospective. SUBJECTS Thirty-five consecutive patients (17 males, median age, 24 months; age range, 6-98 months) with proven hepatoblastoma underwent preoperative MR imaging following neoadjuvant chemotherapy. FIELD STRENGTH/SEQUENCE 3.0 T; T2-weighted imaging (T2WI), T2WI with fat suppression, diffusion weighted imaging, radial stack-of-the-star/Cartesian 3D Dixon T1-weighted gradient echo imaging. ASSESSMENT Three radiologists independently assessed the POSTTEXT stages and annotation factors P and V based on the 2017 PRE/POSTTEXT system. The sensitivities and specificities were calculated for 1) diagnosing each POSTTEXT stage; 2) discrimination of stages III and IV (advanced) from those stages I and II (non-advanced) hepatoblastomas; and 3) annotation factors P and V. The combination of pathologic findings and surgical records served as the reference standard. STATISTICAL TESTS Sensitivity, specificity, Fleiss kappa test. RESULTS The sensitivity and specificity ranges for discriminating advanced from non-advanced hepatoblastomas were 73.3%-80.0% and 80.0%-90.0%, respectively. For annotation factor P, they were 66.7%-100.0% and 90.6%, respectively. For factor V, they were 75.0% and 67.7%-83.9%, respectively. There was excellent, substantial, and moderate agreement on POSTTEXT staging (Fleiss kappa = 0.82), factors P (Fleiss kappa = 0.64), and factors V (Fleiss kappa = 0.60), respectively. DATA CONCLUSION MR POSTTEXT provides reliable discrimination between advanced and non-advanced tumors, and MR has moderate to excellent specificity at identifying portal venous and hepatic venous/IVC involvement. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Xu Hua Gong
- Radiology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Ming Xuan Feng
- Liver Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Zhi Guo Zhuang
- Radiology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Yun Qi Yan
- Radiology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Li Wang
- Radiology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Hai Nan Ren
- Radiology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Yi Zhu
- Radiology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Yang Song
- MR Scientific Marketing, Siemens Healthineers Co Ltd, Shanghai, China
| | - Li Jun Qian
- Radiology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Jian Rong Xu
- Radiology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Yan Zhou
- Radiology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Qiang Xia
- Liver Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
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Arenos-Abril J, Greer MLC. Editorial for "Pediatric Hepatoblastoma After Neoadjuvant Chemotherapy: Diagnostic Performance of MR in Staging POSTTEXT and Vascular Involvement". J Magn Reson Imaging 2024; 59:1043-1044. [PMID: 37285117 DOI: 10.1002/jmri.28849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
- Jesus Arenos-Abril
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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Lin WY, Wu KH, Chen CY, Guo BC, Chang YJ, Lin MJ, Wu HP. Treatment of Undifferentiated Embryonal Sarcoma of the Liver in Children. Cancers (Basel) 2024; 16:897. [PMID: 38473259 DOI: 10.3390/cancers16050897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Undifferentiated embryonal sarcoma of the liver is a rare mesenchymal tumor with a highly malignant potential. It occurs almost exclusively in the pediatric population and typically has a poor outcome. Although previous studies have reported dismal prognoses, recent advances in combined treatment modalities, e.g., surgery and chemotherapy, have given cause for optimism. Even in those diseases not amenable to complete surgical resection or refractory diseases, other treatment modalities, such as liver transplant, have yielded promising results. This paper provides a review of the current treatment modalities for hepatic undifferentiated embryonal sarcoma in children.
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Affiliation(s)
- Wen-Ya Lin
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Kang-Hsi Wu
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 408, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 408, Taiwan
| | - Chun-Yu Chen
- Department of Emergency Medicine, Tungs' Taichung Metro Harbor Hospital, Taichung 43503, Taiwan
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356006, Taiwan
| | - Bei-Cyuan Guo
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70142, Taiwan
| | - Yu-Jun Chang
- Laboratory of Epidemiology and Biostastics, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Mao-Jen Lin
- Division of Cardiology, Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung 427213, Taiwan
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Han-Ping Wu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
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Cao Y, Wu S, Tang H. An update on diagnosis and treatment of hepatoblastoma. Biosci Trends 2024; 17:445-457. [PMID: 38143081 DOI: 10.5582/bst.2023.01311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
Hepatoblastoma (HB) remains the most common paediatric liver tumour and survival in children with hepatoblastoma has improved considerably since the advent of sequential surgical regimens of chemotherapy based on platinum-based chemotherapeutic agents in the 1980s. With the advent of modern diagnostic imaging and pathology techniques, new preoperative chemotherapy regimens and the maturation of surgical techniques, new diagnostic and treatment options for patients with hepatoblastoma have emerged and international collaborations are investigating the latest diagnostic approaches, chemotherapy drug combinations and surgical strategies. Diagnosis of hepatoblastoma relies on imaging studies (such as ultrasound, computed tomography, and magnetic resonance imaging), alpha-fetoprotein (AFP) levels, and histological confirmation through biopsy. The standard treatment approach involves a multimodal strategy with neoadjuvant chemotherapy followed by surgical resection. In cases where complete resection is not feasible or tumors exhibit invasive characteristics, liver transplantation is considered. The management of metastatic and recurrent hepatoblastoma poses significant challenges, and ongoing research focuses on developing targeted therapies and exploring the potential of immunotherapy. Further studies are necessary to gain a better understanding of the etiology of hepatoblastoma, develop prevention strategies, and personalize treatment approaches. We aim to review the current status of diagnosis and treatment of hepatoblastoma.
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Affiliation(s)
- Yinbiao Cao
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China
- The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Shurui Wu
- The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Haowen Tang
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China
- The First Medical Center of the Chinese PLA General Hospital, Beijing, China
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Morin CE, Kolbe AB, Alazraki A, Chavhan GB, Gill A, Infante J, Khanna G, Nguyen HN, O'Neill AF, Rees MA, Sharma A, Squires JE, Squires JH, Syed AB, Tang ER, Towbin AJ, Schooler GR. Cancer Therapy-related Hepatic Injury in Children: Imaging Review from the Pediatric LI-RADS Working Group. Radiographics 2023; 43:e230007. [PMID: 37616168 DOI: 10.1148/rg.230007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
The liver is the primary organ for the metabolism of many chemotherapeutic agents. Treatment-induced liver injury is common in children undergoing cancer therapy. Hepatic injury occurs due to various mechanisms, including biochemical cytotoxicity, hepatic vascular injury, radiation-induced cytotoxicity, and direct hepatic injury through minimally invasive and invasive surgical treatments. Treatment-induced liver injury can be seen contemporaneous with therapy and months to years after therapy is complete. Patients can develop a combination of hepatic injuries manifesting during and after treatment. Acute toxic effects of cancer therapy in children include hepatitis, steatosis, steatohepatitis, cholestasis, hemosiderosis, and vascular injury. Longer-term effects of cancer therapy include hepatic fibrosis, chronic liver failure, and development of focal liver lesions. Quantitative imaging techniques can provide useful metrics for disease diagnosis and monitoring, especially in treatment-related diffuse liver injury such as hepatic steatosis and steatohepatitis, hepatic iron deposition, and hepatic fibrosis. Focal liver lesions, including those developing as a result of treatment-related vascular injury such as focal nodular hyperplasia-like lesions and hepatic perfusion anomalies, as well as hepatic infections occurring as a consequence of immune suppression, can be anxiety provoking and confused with recurrent malignancy or hepatic metastases, although there often are imaging features that help elucidate the correct diagnosis. Radiologic evaluation, in conjunction with clinical and biochemical screening, is integral to diagnosing and monitoring hepatic complications of cancer therapy in pediatric patients during therapy and after therapy completion for long-term surveillance. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material See the invited commentary by Ferraciolli and Gee in this issue.
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Affiliation(s)
- Cara E Morin
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Amy B Kolbe
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Adina Alazraki
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Govind B Chavhan
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Annie Gill
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Juan Infante
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Geetika Khanna
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - HaiThuy N Nguyen
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Allison F O'Neill
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Mitchell A Rees
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Akshay Sharma
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - James E Squires
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Judy H Squires
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Ali B Syed
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Elizabeth R Tang
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Alexander J Towbin
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
| | - Gary R Schooler
- From the Department of Radiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH 45229 (C.E.M., A.J.T.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.B.K.); Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.A., A.G., G.K.); Diagnostic Imaging Department, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Ontario, Canada (G.B.C.); Department of Radiology, Nicklaus Children's Hospital, Miami, Fla (J.I.); Department of Radiology, Children's Hospital Los Angeles, Los Angeles, Calif (H.N.N.); Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Mass (A.F.O.); Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (M.A.R.); Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tenn (A.S.); Division of Gastroenterology, Hepatology, and Nutrition (J.E.S.) and Department of Radiology (J.H.S.), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Radiology, Stanford University, Stanford, Calif (A.B.S.); Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colo (E.R.T.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.)
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8
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Ferraciolli SF, Gee MS. Invited Commentary: Cancer-related Hepatic Injury in Children: Review of Imaging Features Guiding Clinical Management. Radiographics 2023; 43:e230195. [PMID: 37616169 DOI: 10.1148/rg.230195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Suely F Ferraciolli
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit S, AUS-210, Boston, MA 02114; and Department of Radiology, Harvard Medical School, Boston, Mass
| | - Michael S Gee
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit S, AUS-210, Boston, MA 02114; and Department of Radiology, Harvard Medical School, Boston, Mass
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9
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Schoot RA, van Ewijk R, von Witzleben AA, Kao SC, Merks JHMH, Morosi C, Pace E, Shulkin BL, Ferrari A, von Kalle T, van Rijn RR, Weiss AR, Sparber-Sauer M, Ter Horst SAJ, McCarville MB. INternational Soft Tissue saRcoma ConsorTium (INSTRuCT) consensus statement: Imaging recommendations for the management of rhabdomyosarcoma. Eur J Radiol 2023; 166:111012. [PMID: 37541182 DOI: 10.1016/j.ejrad.2023.111012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
Rhabdomyosarcoma is the most common soft-tissue neoplasm in the pediatric population. The survival of children with rhabdomyosarcoma has only marginally improved over the past 25 years and remains poor for those with metastatic disease. A significant challenge to advances in treatment of rhabdomyosarcoma is the relative rarity of this disease, necessitating years to complete clinical trials. Progress can be accelerated by international cooperation and sharing national experiences. This necessitates agreement on a common language to describe patient cohorts and consensus standards to guide diagnosis, treatment, and response assessment. These goals formed the premise for creating the INternational Soft Tissue saRcoma ConsorTium (INSTRuCT) in 2017. Multidisciplinary members of this consortium have since developed international consensus statements on the diagnosis, treatment, and management of pediatric soft-tissue sarcomas. Herein, members of the INSTRuCT Diagnostic Imaging Working Group present international consensus recommendations for imaging of patients with rhabdomyosarcoma at diagnosis, at staging, and during and after completion of therapy. The intent is to promote a standardized imaging approach to pediatric patients with this malignancy to create more-reliable comparisons of results of clinical trials internationally, thereby accelerating progress in managing rhabdomyosarcoma and improving survival.
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Affiliation(s)
- Reineke A Schoot
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Roelof van Ewijk
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Anna-Anais von Witzleben
- Institute of Radiology Olgahospital, Zentrum für Kinder-, Jugend- und Frauenmedizin, Klinikum Stuttgart, Stuttgart, Germany.
| | - Simon C Kao
- Department of Radiology, The University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - J H M Hans Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Carlo Morosi
- Department of Radiology, Istituto Nazionale Tumori, Milan, Italy.
| | - Erika Pace
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, England, United Kingdom.
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Andrea Ferrari
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Istituto Nazionale Tumori, Milan, Italy.
| | - Thekla von Kalle
- Institute of Radiology Olgahospital, Zentrum für Kinder-, Jugend- und Frauenmedizin, Klinikum Stuttgart, Stuttgart, Germany.
| | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Aaron R Weiss
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Maine Medical Center, Portland, ME, USA.
| | - Monika Sparber-Sauer
- Klinikum der Landeshauptstadt Stuttgart gKAöR, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pädiatrie 5 (Pädiatrische Onkologie, Hämatologie, Immunologie), Stuttgart, Germany; University of Medicine Tübingen, Tübingen, Germany.
| | - Simone A J Ter Horst
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, the Netherlands.
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA.
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10
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Thacker PG, Alazraki AL, Beth McCarville M, Tang ER, Towbin AJ. Awareness of a recent special publication on pediatric oncologic imaging: a collaborative effort by the COG Diagnostic Imaging Committee and SPR Oncology Committee. Pediatr Radiol 2023; 53:2154-2156. [PMID: 37442854 DOI: 10.1007/s00247-023-05719-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Paul G Thacker
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA.
| | - Adina L Alazraki
- Departments of Pediatrics and Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Elizabeth R Tang
- Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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11
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Jha SK, Brown C, Kang L, Diaz ES, Gwal K, Alvarez E, Brown EG, Stein-Wexler R. Update on the Role of Imaging in Staging of Common Pediatric Abdominal Tumors. Curr Probl Cancer 2023:100969. [PMID: 37321909 DOI: 10.1016/j.currproblcancer.2023.100969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/17/2023] [Accepted: 05/25/2023] [Indexed: 06/17/2023]
Abstract
Neuroblastoma, Wilms tumor, and hepatoblastoma are the most common pediatric abdominal malignancies. Management of these diseases is a multidisciplinary process that continues to evolve based on the results of international collaborative trials and advances in understanding of tumor biology. Each of these tumors has unique characteristics and behavior which are reflected in their respective staging systems. It is important for clinicians involved in the care of children with abdominal malignancies to be familiar with current staging guidelines and imaging recommendations. This article reviews the current role of imaging in the management of these common pediatric abdominal malignancies, with emphasis on initial staging.
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Affiliation(s)
- Sujit Kumar Jha
- University of California Davis Health, Department of Radiology, Division of Pediatric Radiology, Sacramento, CA, USA
| | - Colin Brown
- University of California Davis Health, Department of Radiology, Division of Pediatric Radiology, Sacramento, CA, USA.
| | - Lisa Kang
- University of California Davis Health, Department of Radiology, Division of Pediatric Radiology, Sacramento, CA, USA
| | - Eric S Diaz
- University of California Davis Health, Department of Radiology, Division of Pediatric Radiology, Sacramento, CA, USA
| | - Kriti Gwal
- University of California Davis Health, Department of Radiology, Division of Pediatric Radiology, Sacramento, CA, USA
| | - Elysia Alvarez
- University of California Davis Health, Department of Pediatrics, Division of Pediatric Hematology and Oncology, Sacramento, CA, USA
| | - Erin G Brown
- University of California Davis Health, Department of Surgery, Division of Pediatric Surgery, Sacramento, CA, USA
| | - Rebecca Stein-Wexler
- University of California Davis Health, Department of Radiology, Division of Pediatric Radiology, Sacramento, CA, USA
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12
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Tang ER, Alazraki AL, Thacker PG, McCarville MB, Towbin AJ. Introduction to the COG Diagnostic Imaging Committee/SPR Oncology Committee White Papers: Rationale and methods. Pediatr Blood Cancer 2023; 70 Suppl 4:e30411. [PMID: 37158569 PMCID: PMC10626871 DOI: 10.1002/pbc.30411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023]
Abstract
Pediatric cancer is a rare disease. Because of this, many sites do not have experience providing imaging for specific tumor types. The Children's Oncology Group Diagnostic Imaging Committee and the Society for Pediatric Radiology Oncology Committee are comprised of radiologists with expertise in pediatric cancer imaging. Recently, this group endeavored to create a series of 23 White Papers designed to provide evidence-based imaging recommendations and minimum achievable imaging protocols. The purpose of this manuscript is to describe the methods employed in authoring the White Paper series.
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Affiliation(s)
- Elizabeth R. Tang
- Department of Radiology, Section of Pediatric Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Adina L. Alazraki
- Departments of Pediatrics and Radiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Paul G. Thacker
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Alexander J. Towbin
- Department of Radiology, Cincinnati Children’s Hospital; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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13
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Schooler GR, Infante JC, Acord M, Alazraki A, Chavhan GB, Davis JC, Khanna G, Morani AC, Morin CE, Nguyen HN, Rees MA, Shaikh R, Srinivasan A, Squires JH, Tang E, Thacker PG, Towbin AJ. Imaging of pediatric liver tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29965. [PMID: 36102690 PMCID: PMC10641897 DOI: 10.1002/pbc.29965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/16/2022] [Indexed: 11/11/2022]
Abstract
Primary hepatic malignancies are relatively rare in the pediatric population, accounting for approximately 1%-2% of all pediatric tumors. Hepatoblastoma and hepatocellular carcinoma are the most common primary liver malignancies in children under the age of 5 years and over the age of 10 years, respectively. This paper provides consensus-based imaging recommendations for evaluation of patients with primary hepatic malignancies at diagnosis and follow-up during and after therapy.
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Affiliation(s)
- Gary R. Schooler
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Juan C. Infante
- Department of Radiology, Nemours Children’s Health, Orlando, FL
| | - Michael Acord
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Adina Alazraki
- Department of Radiology and Imaging Sciences, Emory University, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Govind B. Chavhan
- Department of Diagnostic Imaging, Hospital for Sick Children and Department of Medical Imaging, University of Toronto, ON Canada
| | | | - Geetika Khanna
- Department of Radiology and Imaging Sciences, Emory University, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Ajaykumar C. Morani
- Singleton Department of Radiology, Texas Children’s Hospital and Department of Radiology, Baylor College of Medicine, Houston, TX
| | - Cara E. Morin
- Department of Radiology, Cincinnati Children’s Hospital, Cincinnati, OH
| | - HaiThuy N. Nguyen
- Singleton Department of Radiology, Texas Children’s Hospital and Department of Radiology, Baylor College of Medicine, Houston, TX
| | - Mitchell A. Rees
- Department of Radiology, Nationwide Children’s Hospital, Columbus, OH
| | - Raja Shaikh
- Department of Radiology, Boston Children’s Hospital, Boston, MA
| | - Abhay Srinivasan
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Judy H. Squires
- Department of Radiology, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Elizabeth Tang
- Department of Radiology, Seattle Children’s Hospital, Seattle, WA
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14
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Frush DP, Callahan MJ, Coley BD, Nadel HR, Guillerman RP. Comparison of the different imaging modalities used to image pediatric oncology patients: A COG diagnostic imaging committee/SPR oncology committee white paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e30298. [PMID: 37025033 PMCID: PMC10652359 DOI: 10.1002/pbc.30298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 04/08/2023]
Abstract
Diagnostic imaging is essential in the diagnosis and management, including surveillance, of known or suspected cancer in children. The independent and combined roles of the various modalities, consisting of radiography, fluoroscopy, ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine (NM), are both prescribed through protocols but also function in caring for complications that may occur during or subsequent to treatment such as infection, bleeding, or organ compromise. Use of a specific imaging modality may be based on situational circumstances such as a brain CT or MR for a new onset seizure, chest CT for respiratory signs or symptoms, or US for gross hematuria. However, in many situations, there are competing choices that do not easily lend themselves to a formulaic approach as options; these situations depend on the contributions of a variety of factors based on a combination of the clinical scenario and the strengths and limitations of the imaging modalities. Therefore, an improved understanding of the potential influence of the imaging decision pathways in pediatric cancer care can come from comparison among the individual diagnostic imaging modalities. The purpose of the following material to is to provide such a comparison. To do this, pediatric imaging content experts for the individual modalities of radiography and fluoroscopy, US, CT, MRI, and NM will discuss the individual modality strengths and limitations.
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Affiliation(s)
- Donald P. Frush
- Department of Radiology, Box 3808, Duke University Medical Center, Durham, NC 27710
| | - Michael J. Callahan
- Department of Radiology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115
| | - Brian D. Coley
- Division of Radiology and Medical Imaging, 3333 Burnet Avenue MLC 15017., Children’s Hospital Medical Center, Cincinnati, OH 45229
| | - Helen R. Nadel
- Pediatric Radiology, Lucile Packard Children’s Hospital at Stanford, Stanford University School of Medicine, 725 Welch Rd, MC 5913, Palo Alto, CA 94304
| | - R. Paul Guillerman
- Department of Radiology, Texas Children’s Hospital, 6701 Fannin Street, Suite 470, Houston, TX 77030
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15
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Cekuolis A, Schreiber-Dietrich D, Augustinienė R, Taut H, Squires J, Chaves EL, Dong Y, Dietrich CF. Incidental Findings in Pediatric Patients: How to Manage Liver Incidentaloma in Pediatric Patients. Cancers (Basel) 2023; 15:cancers15082360. [PMID: 37190288 DOI: 10.3390/cancers15082360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental imaging findings-the role of ultrasound". IFs in the liver of newborns and children are rare and much less commonly encountered than in adults; as a result, they are relatively much more frequently malignant and life-threatening, even when they are of benign histology. Conventional B-mode ultrasound is the well-established first line imaging modality for the assessment of liver pathology in pediatric patients. US technological advances, resulting in image quality improvement, contrast-enhanced ultrasound (CEUS), liver elastography and quantification tools for steatosis have expanded the use of ultrasound technology in daily practice. The following overview is intended to illustrate incidentally detected liver pathology covering all pediatric ages. It aims to aid the examiner in establishing the final diagnosis. Management of incidentally detected focal liver lesions (FLL) needs to take into account the diagnostic accuracy of each imaging modality, the patient's safety issues (including ionizing radiation and nephrotoxic contrast agents), the delay in diagnosis, the psychological burden on the patient and the cost for the healthcare system. Moreover, this paper should help the pediatric clinician and ultrasound practitioner to decide which pathologies need no further investigation, which ones require interval imaging and which cases require further and immediate diagnostic procedures.
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Affiliation(s)
- Andrius Cekuolis
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | | | - Rasa Augustinienė
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Heike Taut
- Children's Hospital, Universitätsklinikum Dresden, Technische Universität Dresden, 01062 Dresden, Germany
| | - Judy Squires
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Edda L Chaves
- Radiology Department, Hospital Regional Nicolas Solano, La Chorrera 1007, Panama
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, 3013 Bern, Switzerland
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16
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Adams LC, Jayapal P, Ramasamy SK, Morakote W, Yeom K, Baratto L, Daldrup-Link HE. Ferumoxytol-Enhanced MRI in Children and Young Adults: State of the Art. AJR Am J Roentgenol 2023; 220:590-603. [PMID: 36197052 PMCID: PMC10038879 DOI: 10.2214/ajr.22.28453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ferumoxytol is an ultrasmall iron oxide nanoparticle that was originally approved by the FDA in 2009 for IV treatment of iron deficiency in adults with chronic kidney disease. Subsequently, its off-label use as an MRI contrast agent increased in clinical practice, particularly in pediatric patients in North America. Unlike conventional MRI contrast agents that are based on the rare earth metal gadolinium (gadolinium-based contrast agents), ferumoxytol is biodegradable and carries no potential risk of nephrogenic systemic fibrosis. At FDA-approved doses, ferumoxytol shows no long-term tissue retention in patients with intact iron metabolism. Ferumoxytol provides unique MRI properties, including long-lasting vascular retention (facilitating high-quality vascular imaging) and retention in reticuloendothelial system tissues, thereby supporting a variety of applications beyond those possible with gadolinium-based contrast agents (GBCAs). This Clinical Perspective describes clinical and early translational applications of ferumoxytol-enhanced MRI in children and young adults through off-label use in a variety of settings, including vascular, cardiac, and cancer imaging, drawing on the institutional experience of the authors. In addition, we describe current advances in pre-clinical and clinical research using ferumoxytol in cellular and molecular imaging as well as the use of ferumoxytol as a novel potential cancer therapeutic agent.
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Affiliation(s)
- Lisa C. Adams
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Praveen Jayapal
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Shakthi Kumaran Ramasamy
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Wipawee Morakote
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Kristen Yeom
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Lucia Baratto
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
| | - Heike E. Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Lucile Packard Children’s Hospital, Stanford University, 725 Welch Road, Room 1665, Stanford, CA, 94305-5614, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Cancer Imaging and Early Detection Program, Stanford Cancer Institute, Stanford, CA, USA
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17
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Herrmann J, Petit P, Grabhorn E, Lenz A, Jürgens J, Franchi-Albella S. Liver cirrhosis in children - the role of imaging in the diagnostic pathway. Pediatr Radiol 2023; 53:714-726. [PMID: 36040526 PMCID: PMC10027649 DOI: 10.1007/s00247-022-05480-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/23/2022] [Accepted: 07/31/2022] [Indexed: 10/14/2022]
Abstract
Liver cirrhosis in children is a rare disease with multifactorial causes that are distinct from those in adults. Underlying reasons include cholestatic, viral, autoimmune, hereditary, metabolic and cardiac disorders. Early detection of fibrosis is important as clinical stabilization or even reversal of fibrosis can be achieved in some disorders with adequate treatment. This article focuses on the longitudinal evaluation of children with chronic liver disease with noninvasive imaging tools, which play an important role in detecting cirrhosis, defining underlying causes, grading fibrosis and monitoring patients during follow-up. Ultrasound is the primary imaging modality and it is used in a multiparametric fashion. Magnetic resonance imaging and computed tomography are usually applied second line for refined tissue characterization, clarification of nodular lesions and full delineation of abdominal vessels, including portosystemic communications.
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Affiliation(s)
- Jochen Herrmann
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
| | - Philippe Petit
- Aix Marseille Université, Hopital Timone-Enfants, Marseille, France
| | - Enke Grabhorn
- Department of Pediatric Gastroenterology and Hepatology, University Medical Center Hamburg, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center, Hamburg, Germany
| | - Julian Jürgens
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Stéphanie Franchi-Albella
- Department of Pediatric Radiology, Hôpital Bicêtre, National Reference Centre for Rare Pediatric Liver Diseases, Paris, France
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Smriti V, Baheti AD, Shah S, Qureshi SS, Shetty N, Gala K, Kulkarni S, Raut A, Kamble V, Chinnaswamy G, Prasad M, C. P B, Ramadwar M, Singh S, Shukla A, Panwala H, Sahu A, Siddharth L, Kapadia T. Imaging Recommendations for Diagnosis, Staging, and Management of Pediatric Solid Tumors. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
AbstractPaediatric extra-cranial solid tumours are one of the common causes for paediatric malignancies. Lack of appropriate imaging at presentation, staging and for follow-up is a major challenge for paediatric solid tumours. We have reviewed the paediatric solid tumour imaging protocols suggested by the major oncological societies/groups around the world (mainly the SIOP – Society International Pediatric Oncology, and the COG – Children's Oncology Group). We have adapted some of those protocols to develop imaging recommendations for the diagnosis, staging and management of extra-cranial solid tumours based on the treatment protocols followed in India.
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Affiliation(s)
- Vasundhara Smriti
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Akshay D. Baheti
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine and molecular imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sajid S. Qureshi
- Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nanadan Shetty
- Department of Opthalmology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kunal Gala
- Department of Intervention Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Suyash Kulkarni
- Department of Intervention Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Abhijit Raut
- Department of Radiodiagnosis, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Veenita Kamble
- Department of Radiodiagnosis, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Maya Prasad
- Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Badira C. P
- Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Mukta Ramadwar
- Department of Pathology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Suryaveer Singh
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anuradha Shukla
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Hirenkumar Panwala
- Department of Radiodiagnosis, SRCC Children's Hospital, Mumbai, Maharashtra, India
| | - Arpita Sahu
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Laskar Siddharth
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Tejas Kapadia
- Children's X-ray Department/Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester, United Kingdom
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19
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Chen K, Dong Y, Zhang W, Han H, Mao F, Zhang H, Wang W. Ultrasound-Guided Coarse Needle Biopsy Diagnosed Isolated Hepatic Malignant Melanoma with Undetermined Origin in TB Patient: A Case Report. Diagnostics (Basel) 2022; 13:diagnostics13010042. [PMID: 36611333 PMCID: PMC9818511 DOI: 10.3390/diagnostics13010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022] Open
Abstract
Isolated hepatic malignant melanoma with undetermined origin is relatively rare and the imaging findings vary significantly in published studies. In this report, we described an elderly male patient with pulmonary tuberculosis who was diagnosed with isolated hepatic malignant melanoma with undetermined origin by ultrasound-guided percutaneous coarse needle biopsy (US-CNB). The hepatic melanoma was detected accidentally on chest CT. On contrast-enhanced ultrasound (CEUS), it presented an enhancement pattern of fast washin and slow washout. However, on magnetic resonance imaging (CEMRI), it showed non-rim hyperenhancement in the arterial phase but hypointensity in the late phase, mimicking hepatocellular carcinoma. With inconsistent results, the patient underwent fluorine-18-fluro-2-deoxy-D-glucose-positron emission tomography/computed tomography (18F-FDG-PET/CT). The mass showed mild 18F-FDG uptake with SUVmax of 4.7, and hypermetabolic nodules were observed in the lung, chest wall, thoracic vertebra, and pelvis. Due to the advanced stage of the tumor, US-CNB was performed to acquire a pathological diagnosis. The immunohistochemical staining suggested malignant melanoma. Of note, no primary tumor was revealed. Finally, the patient refused systemic therapy and died from tumor progression seven months later. Hence, CEUS and CEMRI is fundamental in the diagnosis of hepatic melanoma, and PET-CT is helpful in clinical staging. For controversial results, US-CNB is required to establish the pathological diagnosis.
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Affiliation(s)
- Kailing Chen
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong Universitity School of Medicine, Shanghai 200092, China
| | - Weibin Zhang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hong Han
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Feng Mao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hui Zhang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wenping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Correspondence: ; Tel.: +86-021-64041990-2474; Fax: +86-021-64220319
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20
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Chavhan GB, Schooler GR, Tang ER, Squires JH, Rees MA, Nguyen HN, Morin CE, Kolbe AB, Khanna G, Infante JC, Alazraki AL, Towbin AJ. Optimizing Imaging of Pediatric Liver Lesions: Guidelines from the Pediatric LI-RADS Working Group. Radiographics 2022; 43:e220043. [DOI: 10.1148/rg.220043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Squires JH, Fetzer DT, Dillman JR. Practical Contrast Enhanced Liver Ultrasound. Radiol Clin North Am 2022; 60:717-730. [DOI: 10.1016/j.rcl.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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22
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Falqueto LE, Vilar PR, Campos HG, Schulz C, Mattos E Silva EDE. Primary Malignant Liver Tumors: eight-year experience in a Pediatric Hospital in Brazil. A cross-sectional study. Rev Col Bras Cir 2022; 49:e20223273. [PMID: 35703678 PMCID: PMC10578837 DOI: 10.1590/0100-6991e-20223273-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION liver tumors are rare neoplasms in childhood (1-2%), and about 2/3 are malignant. Hepatoblastoma (HB) is the most frequent, followed by hepatocellular carcinoma (HCC). In both, the main treatment is surgical resection. Currently, chemotherapy and liver transplantation have improved outcomes. OBJECTIVE study of the epidemiological profile and evolution of liver cancer cases in a referral pediatric hospital. METHODOLOGY a retrospective survey of medical records of patients aged up to 18 years with a diagnosis of primary malignant hepatic neoplasm between 2012 and 2020, carried out in the largest exclusively pediatric hospital in Brazil. RESULTS a total of 13 patients with malignant liver tumors (HB 12, HCC 1) were treated. Of the HB cases, 66,7% were male, with a mean age of 2 years and the main alteration in the palpable abdominal mass. Tumors involved an average of 3 liver segments, more in the right lobe (54%). Only one patient was treated with surgery without neoadjuvant therapy, another one underwent transplantation like the first treatment, and another 2 required liver transplantation as a rescue. The middle follow-up time of patients with HB was 39 months and only 1 case died due to febrile neutropenia. The 5-year overall and disease-free survival was 91.7% and 81.5%, respectively. CONCLUSION Advanced staging at the time of diagnosis has always been a poor prognostic factor in patients with primary malignant liver tumors. However, the results and survival have improved with the advancement of chemotherapy, surgical technique, and liver transplantation.
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Affiliation(s)
| | - Paula Rubio Vilar
- - Hospital Pequeno Príncipe, Cirurgia Pediátrica - Curitiba - PR - Brasil
| | | | - Claudio Schulz
- - Hospital Pequeno Príncipe, Cirurgia Pediátrica - Curitiba - PR - Brasil
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23
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Jiang ZP, Zeng KY, Huang JY, Yang J, Yang R, Li JW, Qiu TT, Luo Y, Lu Q. Differentiating malignant and benign focal liver lesions in children using CEUS LI-RADS combined with serum alpha-fetoprotein. World J Gastroenterol 2022; 28:2350-2360. [PMID: 35800178 PMCID: PMC9185218 DOI: 10.3748/wjg.v28.i21.2350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/08/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) can be used to diagnose focal liver lesions (FLLs) in children. The America College of Radiology developed the CEUS liver imaging reporting and data system (LI-RADS) for standardizing CEUS diagnosis of FLLs in adult patients. Until now, no similar consensus or guidelines have existed for pediatric patients to improve imaging interpretation as adults.
AIM To evaluate the performance of CEUS LI-RADS combined with alpha-fetoprotein (AFP) in differentiating benign and malignant FLLs in pediatric patients.
METHODS Between January 2011 and January 2021, patients ≤ 18 years old who underwent CEUS for FLLs were retrospectively evaluated. The following criteria for diagnosing malignancy were proposed: Criterion I considered LR-4, LR-5, or LR-M lesions as malignancies; criterion II regarded LR-4, LR-5 or LR-M lesions with simultaneously elevated AFP (≥ 20 ng/mL) as malignancies; criterion III took LR-4 Lesions with elevated AFP or LR-5 or LR-M lesions as malignancies. The sensitivity, specificity, accuracy and area under the receiver operating characteristic curve (AUC) were calculated to determine the diagnostic value of the aforementioned criteria.
RESULTS The study included 63 nodules in 60 patients (mean age, 11.0 ± 5.2 years; 26 male). There were no statistically significant differences between the specificity, accuracy, or AUC of criterion II and criterion III (95.1% vs 80.5%, 84.1% vs 87.3%, and 0.794 vs 0.902; all P > 0.017). Notably, criterion III showed a higher diagnostic sensitivity than criterion II (100% vs 63.6%; P < 0.017). However, both the specificity and accuracy of criterion I was inferior to those of criterion II and criterion III (all P < 0.017). For pediatric patients more than 5 years old, the performance of the three criteria was overall similar when patients were subcategorized by age when compared to all patients in aggregate.
CONCLUSION CEUS LI-RADS combined with AFP may be a powerful diagnostic tool in pediatric patients. LR-4 with elevated AFP, LR-5 or LR-M lesions is highly suggestive of malignant tumors.
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Affiliation(s)
- Zhen-Peng Jiang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ke-Yu Zeng
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jia-Yan Huang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jie Yang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Rui Yang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jia-Wu Li
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ting-Ting Qiu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yan Luo
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qiang Lu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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24
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Tsvetkova V, Magro G, Broggi G, Luchini C, Cappello F, Caporalini C, Buccoliero AM, Santoro L. New insights in gastrointestinal "pediatric" neoplasms in adult patients: pancreatoblastoma, hepatoblastoma and embryonal sarcoma of the liver. A practical approach by GIPPI-GIPAD Groups. Pathologica 2022; 114:64-78. [PMID: 35212317 PMCID: PMC9040550 DOI: 10.32074/1591-951x-559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 12/11/2022] Open
Abstract
Pediatric solid neoplasms are rare and very different from those observed in adults. The majority of them are referred to as embryonal because they arise as a result of alterations in the processes of organogenesis or normal growth and are characterized by proliferation of primitive cells, reproducing the corresponding tissue at various stages of embryonic development. This review will focus on embryonal gastrointestinal pediatric neoplasms in adult patients, including pancreatoblastoma, hepatoblastoma, and embryonal sarcoma of the liver. Although they are classically considered pediatric neoplasms, they may (rarely) occur in adult patients. Hepatoblastoma represents the most frequent liver neoplasm in the pediatric population, followed by hepatocellular carcinoma and embryonal sarcoma of the liver; while pancreatoblastoma is the most common malignant pancreatic tumor in childhood. Both in children and adults, the mainstay of treatment is complete surgical resection, either up front or following neoadjuvant chemotherapy. Unresectable and/or metastatic neoplasms may be amenable to complete delayed surgery after neoadjuvant chemotherapy. However, these neoplasms display a more aggressive behavior and overall poorer prognosis in adults than in children, probably because they are diagnosed in later stages of diseases.
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Affiliation(s)
- Vassilena Tsvetkova
- Department of Diagnostics and Public Health, Section of Pathology, Verona University and Hospital Trust; Verona, Italy
| | - Gaetano Magro
- Department of Medical and Surgical Sciences and Advanced Technologies "G. F. Ingrassia", Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies "G. F. Ingrassia", Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, Verona University and Hospital Trust; Verona, Italy
| | - Filippo Cappello
- Department of Pathology, Azienda Ospedaliera Universitaria di Padova, Padova, Italy
| | | | | | - Luisa Santoro
- Department of Pathology, Azienda Ospedaliera Universitaria di Padova, Padova, Italy
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25
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Chavhan GB, Farras Roca L, Coblentz AC. Liver magnetic resonance imaging: how we do it. Pediatr Radiol 2022; 52:167-176. [PMID: 33797616 DOI: 10.1007/s00247-021-05053-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/04/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
Magnetic resonance imaging is used for evaluating focal liver lesions, hepatic vascular diseases, biliary diseases and diffuse liver diseases in children. MRI examinations take a long time, often requiring sedation or anesthesia in smaller children. This makes it essential to understand the concepts and technique necessary to obtain an optimal examination for answering the clinical question while minimizing the need for sedation/anesthesia. We discuss key concepts including appropriate sequence selection, choice of contrast media, dynamic imaging, phases of contrast enhancement and protocol organization.
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Affiliation(s)
- Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Lara Farras Roca
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Ailish C Coblentz
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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Vasireddi AK, Leo ME, Squires JH. Magnetic resonance imaging of pediatric liver tumors. Pediatr Radiol 2022; 52:177-188. [PMID: 33852026 DOI: 10.1007/s00247-021-05058-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/04/2021] [Accepted: 03/16/2021] [Indexed: 12/14/2022]
Abstract
Liver tumors in children can be benign or malignant. Although several clinical factors are important in the evaluation of these lesions, MRI is particularly important for lesion characterization and tumor staging. In children, use of a hepatobiliary contrast agent is recommended to evaluate a known or suspected liver lesion. In this review, we discuss the most common benign and malignant pediatric liver tumors, including vascular tumors, mesenchymal hamartoma, focal nodular hyperplasia, hepatocellular adenoma, hepatoblastoma, hepatocellular carcinoma, fibrolamellar hepatocellular carcinoma, undifferentiated embryonal sarcoma and metastases, with emphasis on relevant clinical information and imaging appearance at MRI using hepatobiliary agents.
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Affiliation(s)
- Anil K Vasireddi
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Madeline E Leo
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Judy H Squires
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. .,Department of Pediatric Radiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave., 2nd Floor Radiology, Pittsburgh, PA, 15224, USA.
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FALQUETO LORAINEENTRINGER, VILAR PAULARUBIO, CAMPOS HELDERGROENWOLD, SCHULZ CLAUDIO, MATTOS E SILVA ELISANGELADE. Neoplasias Malignas Primárias do Fígado: experiência de oito anos de um Hospital Pediátrico no Brasil. Estudo transversal. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Introdução: tumores hepáticos são neoplasias raras na infância (1-2%), sendo que cerca de 2/3 são malignos. O hepatoblastoma (HB) é o mais frequente, seguido do carcinoma hepatocelular (CHC). Em ambos, o principal tratamento é a ressecção cirúrgica completa. Atualmente, a quimioterapia e o transplante hepático têm melhorado os resultados. Objetivo: estudo do perfil epidemiológico e evolução dos casos de cânceres hepáticos em um hospital pediátrico de referência. Método: Levantamento retrospectivo de prontuários de pacientes até 18 anos com diagnóstico de neoplasia maligna primária hepática entre 2012 e 2020 realizado no maior hospital exclusivamente pediátrico do Brasil. Resultados: foram atendidos 13 pacientes com tumores malignos hepáticos (HB 12, CHC 1). Dos casos de HB, 66,7% eram do sexo masculino, com idade média de 2 anos e a principal alteração foi massa abdominal palpável. Os tumores envolviam em média 3 segmentos hepáticos, mais em lobo direito (54%). Um paciente foi tratado com cirurgia sem neoadjuvância, um foi submetido a transplante inicialmente e outros 2 necessitaram de transplante hepático como resgate. O tempo de seguimento dos pacientes com HB foi de 39 meses e apenas 1 caso foi a óbito por neutropenia febril. A sobrevida geral e livre de doença em 5 anos foi de 91,7% e 81,5% respectivamente. Conclusão: o estadiamento avançado no momento do diagnóstico sempre foi um fator de mau prognóstico em pacientes com tumores hepáticos malignos primários. Entretanto, os resultados e a sobrevida têm melhorado significativamente com o avanço da quimioterapia, da técnica cirúrgica e do transplante hepático.
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Kim HHR, Hull NC, Lee EY, Phillips GS. Pediatric Abdominal Masses: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:113-129. [PMID: 34836559 DOI: 10.1016/j.rcl.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pediatric abdominal masses are commonly encountered in the pediatric population, with a broad differential diagnosis that encompasses benign and malignant entities. The primary role of abdominal imaging in the setting of a suspected pediatric abdominal mass is to establish its presence, as nonneoplastic entities can mimic an abdominal mass, and to identify characteristic imaging features that narrow the differential diagnosis. In the setting of a neoplasm, various imaging modalities play an important role to characterize the mass, stage extent of disease, and assist in presurgical planning. The purpose of this article is to discuss a practical imaging algorithm for suspected pediatric abdominal masses and to describe typical radiological findings of the commonly encountered abdominal masses in neonates and children with emphasis on imaging guidelines and recommendations.
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Affiliation(s)
- Helen H R Kim
- Department of Radiology, Seattle Children's Hospital and University of Washington, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA.
| | - Nathan C Hull
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 330 Longwood Avenue, Boston, MA 02115, USA
| | - Grace S Phillips
- Department of Radiology, Seattle Children's Hospital and University of Washington, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
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Abstract
Malignant primary liver tumors are rare in children. Yet a wide histologic spectrum is seen, particularly in hepatoblastoma, the most common malignant liver tumor in children. Furthermore, there can be significant morphologic overlap with hepatocellular carcinoma, the second most common pediatric liver malignancy, and tumors with hybrid features of hepatoblastoma and hepatocellular carcinoma are also reported (currently placed in the provisional category of malignant hepatocellular neoplasm, not otherwise specified). This review provides detailed morphologic descriptions and updates in the evolving clinical context of these tumors, and presents recent molecular advances that may further help in accurate classification of these tumors, which is critical in their management.
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Affiliation(s)
- Soo-Jin Cho
- Department of Pathology, University of California San Francisco, 1825 4th Street Room M2369, Box 4066, San Francisco, CA 94143, USA.
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Imaging for Staging of Pediatric Abdominal Tumors: An Update, From the AJR Special Series on Cancer Staging. AJR Am J Roentgenol 2021; 217:786-799. [PMID: 33825502 DOI: 10.2214/ajr.20.25310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The three most common pediatric solid tumors of the abdomen are neuroblastoma, Wilms tumor, and hepatoblastoma. These embryonal tumors most commonly present in the first decade of life. Each tumor has unique imaging findings, including locoregional presentation and patterns of distant spread. Neuroblastoma, Wilms tumor, and hepatoblastoma have unique staging systems that rely heavily on imaging and influence surgical and oncologic management. The staging systems include image-defined risk factors for neuroblastoma, the Children's Oncology Group staging system for Wilms tumor, and the pretreatment extent of tumor system (PRETEXT) for hepatoblastoma. It is important for radiologists to be aware of these staging systems to optimize image acquisition and interpretation. This article provides a practical and clinically oriented approach to the role of imaging in the staging of these common embryonal tumors of childhood. The selection among imaging modalities, key findings for determining tumor stage, and the role of imaging in posttreatment response evaluation and surveil-lance are discussed. Recent updates to the relevant staging systems are highlighted with attention to imaging findings of particular prognostic importance. The information presented will help radiologists tailor the imaging approach to the individual patient and guide optimal oncologic management.
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[Imaging of hepatic tumors in children and adolescents]. Radiologe 2021; 61:629-638. [PMID: 34061213 PMCID: PMC8257542 DOI: 10.1007/s00117-021-00851-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pediatric liver tumors are relatively rare, but thorough knowledge of their imaging features is still important. OBJECTIVES Frequency and imaging features of benign and malignant liver masses during childhood and adolescence. MATERIALS AND METHODS Discussion of relevant original articles, review manuscripts and expert recommendations concerning imaging of childhood liver tumors. RESULTS The most common malignant tumors of the liver are hepatoblastoma, which usually occur in younger children, as well as in some regions hepatocellular carcinoma. In contrast to most benign masses, such as focal nodular hyperplasia, simple cysts or fatty liver infiltrations, their imaging morphology is not very characteristic. Radiologically, sonography and magnetic resonance imaging (MRI) are used for assessment. Both methods benefit from intravenous contrast agent administration. CONCLUSIONS Childhood liver tumors show a broad spectrum of morphological manifestations. Some entities can be characterized using standard imaging, some require multimodal imaging or histological assessment. In addition to morphological imaging criteria, age and the medical history as well as laboratory data play an important role in establishing the correct diagnosis.
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Bien E, Roganovic J, Krawczyk MA, Godzinski J, Orbach D, Cecchetto G, Barthlen W, Defachelles AS, Ferrari A, Weldon CB, Brecht IB, Schneider DT, Bisogno G, Kolenova A, Ben-Ami T, Martinova K, Virgone C, Stachowicz-Stencel T, Kachanov D, Reguerre Y. Pancreatoblastoma in children: EXPeRT/PARTNER diagnostic and therapeutic recommendations. Pediatr Blood Cancer 2021; 68 Suppl 4:e29112. [PMID: 34174157 DOI: 10.1002/pbc.29112] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 12/17/2022]
Abstract
Pancreatoblastoma (PBL) is a rare malignant epithelial neoplasm that affects typically young children. Signs related to advanced upper-abdominal tumor accompanied by elevated serum α-fetoprotein levels in a young child suggest PBL, however histopathological confirmation is mandatory. The mainstay of the treatment is a complete surgical resection. Unresectable and/or metastatic PBL may become amenable to complete delayed surgery after neoadjuvant chemotherapy. This manuscript presents the international consensus recommendations for the diagnosis and treatment of children with PBL, established by the European Cooperative Study Group for Pediatric Rare Tumors (EXPeRT) within the EU-funded PARTNER (Paediatric Rare Tumors Network - European Registry) project.
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Affiliation(s)
- Ewa Bien
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Jelena Roganovic
- Department of Pediatrics, Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia
| | - Malgorzata A Krawczyk
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Jan Godzinski
- Department of Pediatric Surgery, Marciniak Hospital, Wroclaw, Poland.,Department of Pediatric Traumatology and Emergency Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
| | - Giovanni Cecchetto
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Winfred Barthlen
- Pediatric Surgery, Universitaetsmedizin Greifswald, Greifswald, Germany
| | | | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Christopher B Weldon
- Departments of Surgery, Oncology and Anesthesiology, Boston Children's Hospital, Dana-Farber Cancer Institute, Harvard University, Boston, Massachusetts, USA
| | - Ines B Brecht
- Pediatric Hematology and Oncology, Children's Hospital, Eberhard-Karls-Universitaet Tübingen, Tübingen, Germany
| | | | - Gianni Bisogno
- Hematology-Oncology Division, Department of Pediatrics, Padova University Hospital, Padua, Italy
| | | | - Tal Ben-Ami
- Pediatric Hematology Unit, Kaplan Medical Center, Rehovot, Israel
| | - Kata Martinova
- Department of Hematology and Oncology, University Clinic for Children`s Diseases, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of North Macedonia
| | - Calogero Virgone
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | | | - Denis Kachanov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Yves Reguerre
- Department of Pediatric Hematology and Oncology, Félix Guyon University Hospital, St Denis, Réunion Island, France
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Contrast-Enhanced Ultrasound in Children: Implementation and Key Diagnostic Applications. AJR Am J Roentgenol 2021; 217:1217-1231. [PMID: 33908269 DOI: 10.2214/ajr.21.25713] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) utilization is expanding rapidly, particularly in children, in whom the modality offers important advantages of dynamic evaluation of the vasculature, portability, lack of ionizing radiation, and lack of need for sedation. Accumulating data establish an excellent safety profile of ultrasound contrast agents in children. Although only FDA-approved for IV use in children for characterizing focal liver lesions and for use during echocardiography, growing off-label applications are expanding the diagnostic potential of ultrasound. Focal liver lesion evaluation is the most common use of CEUS, and the American College of Radiology Pediatric LI-RADS Working Group recommends including CEUS for evaluation of a newly discovered focal liver lesion in many circumstances. Data also support the role of CEUS in hemodynamically stable children with blunt abdominal trauma, and CEUS is becoming a potential alternative to CT in this setting. Additional potential applications that require further study include evaluation of pathology in the lung, spleen, brain, pancreas, bowel, kidney, female pelvis, and scrotum. This review explores the implementation of CEUS in children, describing basic principles of ultrasound contrast agents and CEUS technique and summarizing current and potential IV diagnostic applications based on pediatric-specific supporting evidence.
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Wang G, Xie X, Chen H, Zhong Z, Zhou W, Jiang H, Xie X, Zhou L. Development of a pediatric liver CEUS criterion to classify benign and malignant liver lesions in pediatric patients: a pilot study. Eur Radiol 2021; 31:6747-6757. [PMID: 33666698 DOI: 10.1007/s00330-021-07784-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/09/2020] [Accepted: 02/12/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To analyze the contrast-enhanced ultrasound (CEUS) characteristics of pediatric patients with focal liver lesions (FLLs) and develop a pediatric liver CEUS criterion to improve the diagnostic performance of CEUS in differentiating pediatric benign and malignant liver lesions. METHODS Between March 2011 and May 2020, patients < 18 years who underwent CEUS were retrospectively evaluated. The CEUS characteristics of FLLs were analyzed. A pediatric liver CEUS criterion categorized as CEUS-1 to CEUS-5 was developed. The diagnostic performance of the criterion (i.e., sensitivity, specificity, PPV, and NPV) was assessed. Chi-square and Mann-Whitney tests were used. RESULTS After exclusion, the study included 130 lesions (mean diameter, 7.1 cm; range, 0.8-17.0 cm) from 130 patients (mean age, 36.0 months; range, 0.03-204.0 months; 74 boys). Hyperenhancement with washout in patients < 5 years or with early washout (≤ 45 s) was used to predict hepatoblastoma, with a sensitivity and specificity of 90.7% (95% confidence interval [CI]: 77.9%, 97.4%) and 93.6% (95% CI: 84.3%, 98.2%), respectively. Peripheral discontinuous globular hyperenhancement was used to diagnose hemangioma, with a sensitivity and specificity of 84.6% (95% CI: 65.1%, 95.6%) and 100% (95% CI: 95.4%, 100.0%), respectively. The rates of malignancies within the pediatric liver CEUS-1, CEUS-2, CEUS-3, CEUS-4, and CEUS-5 categories were 0.0%, 0.0%, 5.6%, 50.0%, and 96.1%, respectively. Besides, the incidences of hepatoblastoma in pediatric liver CEUS-3, CEUS-4, and CEUS-5 were 5.6%, 16.7%, and 67.5%, respectively. CONCLUSIONS The pediatric liver CEUS criterion is useful in differentiating benign focal liver lesions from malignancies, especially hepatoblastoma from hemangioma. KEY POINTS • Hyperenhancement with washout in patients <v5 years or with early washout (≤ 45 s) were used to predict hepatoblastoma, with a sensitivity and specificity of 90.7% and 93.6%. • Peripheral discontinuous globular hyperenhancement was used to diagnose hemangioma, with a sensitivity and specificity of 84.6% and 100.0%. • The rates of malignancies within the pediatric liver CEUS-1, CEUS -2, CEUS-3, CEUS-4, and CEUS-5 categories were 0.0%, 0.0%, 5.6%, 50.0%, and 96.1%, respectively.
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Affiliation(s)
- Guotao Wang
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Xiaohua Xie
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Huadong Chen
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Zhihai Zhong
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Wenying Zhou
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Hong Jiang
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Luyao Zhou
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China.
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Khanna G, Chavhan GB, Schooler GR, Fraum TJ, Alazraki AL, Squires JH, Salter A, Podberesky DJ, Towbin AJ. Diagnostic Performance of LI-RADS Version 2018 for Evaluation of Pediatric Hepatocellular Carcinoma. Radiology 2021; 299:190-199. [PMID: 33620289 DOI: 10.1148/radiol.2021203559] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The Liver Imaging Reporting and Data System (LI-RADS) has standardized the evaluation of adult but not pediatric hepatocellular carcinoma (HCC). Purpose To evaluate the performance of LI-RADS version 2018 for diagnosis of pediatric HCC. Materials and Methods This multi-institution retrospective study evaluated all available dynamic CT and/or MRI scans of pediatric (≤18 years) HCC from five institutions between July 2009 and April 2019. The control group included an equal number of other enhancing hepatic lesions. Blinded to final diagnosis, three radiologists independently applied LI-RADS version 2018 criteria. The reference standard was pathologic examination or more than 1 year follow-up. Sensitivity and specificity of LI-RADS were computed using a dichotomous classification of LR-1, LR-2, or LR-3 versus LR-4, LR-5, LR-TIV (tumor in vein), or LR-M (probably or definitely malignant but not HCC-specific) for predicting hepatic malignancy in the entire cohort and in patients at risk for HCC. Results The cohort consisted of 116 children: 58 with HCC (mean age, 12 years ± 5; 31 girls) and 58 with other enhancing hepatic masses (mean age, 12 years ± 5; 42 girls). Frequencies of major criteria in classic HCC for the three readers were as follows: nonrim arterial phase hyperenhancement, 49%-62% (19-24 of 39 patients); nonperipheral "washout," 36%-59% (14-23 of 39 patients); and enhancing "capsule," 28%-38% (11-15 of 39 patients). For the full cohort, the sensitivity of LR-4, LR-5, LR-TIV, or LR-M for malignancy among the three readers ranged from 85% (95% CI: 76, 94) to 88% (95% CI: 80, 96); specificity of LR-1, LR-2, or LR-3 for benignity ranged from 54% (95% CI: 40, 68) to 70% (95% CI: 57, 83). In the at-risk subgroup, sensitivity ranged from 58% (95% CI: 36, 80) to 68% (95% CI: 48, 89); specificity ranged from 56% (95% CI: 37, 74) to 63% (95% CI: 45, 81). All lesions categorized as LR-TIV (n = 10-13) were HCCs. Conclusion Liver Imaging Reporting and Data System version 2018 had moderate sensitivity but low specificity for the diagnosis of pediatric hepatocellular carcinoma (HCC), which had low frequencies of the major criteria used for adult HCC diagnosis. © RSNA, 2021 See also the editorial by Paltiel in this issue.
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Affiliation(s)
- Geetika Khanna
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131-MIR, St Louis, MO 63110 (G.K., T.J.F.); Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada (G.B.C.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.); Department of Radiology, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.L.A.); Department of Radiology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pa (J.H.S.); Division of Biostatistics, Washington University School of Medicine, St Louis, Mo (A.S.); Nemours Children's Hospital, Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Department of Radiology, Cincinnati Children's Hospital, and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T.)
| | - Govind B Chavhan
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131-MIR, St Louis, MO 63110 (G.K., T.J.F.); Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada (G.B.C.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.); Department of Radiology, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.L.A.); Department of Radiology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pa (J.H.S.); Division of Biostatistics, Washington University School of Medicine, St Louis, Mo (A.S.); Nemours Children's Hospital, Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Department of Radiology, Cincinnati Children's Hospital, and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T.)
| | - Gary R Schooler
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131-MIR, St Louis, MO 63110 (G.K., T.J.F.); Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada (G.B.C.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.); Department of Radiology, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.L.A.); Department of Radiology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pa (J.H.S.); Division of Biostatistics, Washington University School of Medicine, St Louis, Mo (A.S.); Nemours Children's Hospital, Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Department of Radiology, Cincinnati Children's Hospital, and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T.)
| | - Tyler J Fraum
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131-MIR, St Louis, MO 63110 (G.K., T.J.F.); Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada (G.B.C.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.); Department of Radiology, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.L.A.); Department of Radiology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pa (J.H.S.); Division of Biostatistics, Washington University School of Medicine, St Louis, Mo (A.S.); Nemours Children's Hospital, Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Department of Radiology, Cincinnati Children's Hospital, and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T.)
| | - Adina L Alazraki
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131-MIR, St Louis, MO 63110 (G.K., T.J.F.); Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada (G.B.C.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.); Department of Radiology, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.L.A.); Department of Radiology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pa (J.H.S.); Division of Biostatistics, Washington University School of Medicine, St Louis, Mo (A.S.); Nemours Children's Hospital, Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Department of Radiology, Cincinnati Children's Hospital, and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T.)
| | - Judy H Squires
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131-MIR, St Louis, MO 63110 (G.K., T.J.F.); Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada (G.B.C.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.); Department of Radiology, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.L.A.); Department of Radiology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pa (J.H.S.); Division of Biostatistics, Washington University School of Medicine, St Louis, Mo (A.S.); Nemours Children's Hospital, Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Department of Radiology, Cincinnati Children's Hospital, and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T.)
| | - Amber Salter
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131-MIR, St Louis, MO 63110 (G.K., T.J.F.); Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada (G.B.C.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.); Department of Radiology, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.L.A.); Department of Radiology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pa (J.H.S.); Division of Biostatistics, Washington University School of Medicine, St Louis, Mo (A.S.); Nemours Children's Hospital, Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Department of Radiology, Cincinnati Children's Hospital, and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T.)
| | - Daniel J Podberesky
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131-MIR, St Louis, MO 63110 (G.K., T.J.F.); Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada (G.B.C.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.); Department of Radiology, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.L.A.); Department of Radiology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pa (J.H.S.); Division of Biostatistics, Washington University School of Medicine, St Louis, Mo (A.S.); Nemours Children's Hospital, Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Department of Radiology, Cincinnati Children's Hospital, and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T.)
| | - Alexander J Towbin
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131-MIR, St Louis, MO 63110 (G.K., T.J.F.); Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada (G.B.C.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.R.S.); Department of Radiology, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga (A.L.A.); Department of Radiology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pa (J.H.S.); Division of Biostatistics, Washington University School of Medicine, St Louis, Mo (A.S.); Nemours Children's Hospital, Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Department of Radiology, Cincinnati Children's Hospital, and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio (A.J.T.)
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Paltiel HJ. LI-RADS Version 2018 Is of Limited Use in the Diagnosis of Hepatocellular Carcinoma in Children. Radiology 2021; 299:200-201. [PMID: 33625282 DOI: 10.1148/radiol.2021204480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Harriet J Paltiel
- From the Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115
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LI-RADS: Past, Present, and Future, From the AJR Special Series on Radiology Reporting and Data Systems. AJR Am J Roentgenol 2021; 216:295-304. [DOI: 10.2214/ajr.20.24272] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Fang C, Anupindi SA, Back SJ, Franke D, Green TG, Harkanyi Z, Jüngert J, Kwon JK, Paltiel HJ, Squires JH, Zefov VN, McCarville MB. Contrast-enhanced ultrasound of benign and malignant liver lesions in children. Pediatr Radiol 2021; 51:2181-2197. [PMID: 33978801 PMCID: PMC8566652 DOI: 10.1007/s00247-021-04976-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/17/2020] [Accepted: 01/14/2021] [Indexed: 12/14/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) is increasingly being used in children. One of the most common referrals for CEUS performance is characterization of indeterminate focal liver lesions and follow-up of known liver lesions. In this setting, CEUS is performed with intravenous administration of ultrasound contrast agents (UCAs). When injected into a vein, UCA microbubbles remain confined within the vascular network until they dissipate. Therefore, visualization of UCA within the tissues and lesions corresponds to true blood flow. CEUS enables continuous, real-time observation of the enhancement pattern of a focal liver lesion, allowing in most cases for a definite diagnosis and obviating the need for further cross-sectional imaging or other interventional procedures. The recent approval of Lumason (Bracco Diagnostics, Monroe Township, NJ) for pediatric liver CEUS applications has spurred the widespread use of CEUS. In this review article we describe the role of CEUS in pediatric liver applications, focusing on the examination technique and interpretation of main imaging findings of the most commonly encountered benign and malignant focal liver lesions. We also compare the diagnostic performance of CEUS with other imaging modalities for accurate characterization of focal liver lesions.
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Affiliation(s)
- Cheng Fang
- Department of Radiology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - Sudha A. Anupindi
- Department of Radiology, Perelman School of Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA USA
| | - Susan J. Back
- Department of Radiology, Perelman School of Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA USA
| | - Doris Franke
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | | | - Zoltan Harkanyi
- Department of Radiology, Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Jörg Jüngert
- Department of Pediatrics, Friedrich-Alexander University Erlangen–Nürnberg, Erlangen, Germany
| | - Jeannie K. Kwon
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Harriet J. Paltiel
- Department of Radiology, Harvard Medical School, Boston Children’s Hospital, Boston, MA USA
| | - Judy H. Squires
- Department of Radiology, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Vassil N. Zefov
- Department of Radiology, Dubai Health Authority, Latifa Women and Children Hospital, Dubai, UAE
| | - M. Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN USA
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